Form - J

(See Rule 11)

CONSENT OF WOMEN WORKER TO WORK IN NIGHTSHIFT

I Miss / Smt. __________________________________residing at ____________________________

______________________________________________________________________ (Full Address)
State that I am working as (Designation) ____________________ in M/s. ______________________
_______________________________ since ____________________________ I am aware that, -
the employer will provide safe transport facility from the doorstep of my residence to the place of
work and vice-versa-and that there will be at least three women worker working in the nightshift
and that there is a Committee to prevent sexual harassment at work place under the Chairmanship
of Smt.__________________________________

Date :

Place :
Signature/Thumb impression
Of the Women worker.

Name, address, Signature of witnesses:

1. _____________________________
2. _____________________________